肝脏恶性肿瘤合并肝外转移的外科治疗
Surgical treatment of liver malignant tumors with extra-hepatic metastasis
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摘要:
随着疾病筛查手段及影像学检查的发展，肝癌合并肝外转移的检出率逐年增加，手术切除率亦逐年增加。肝癌合并肝外转移尚无统一的治疗标准。本文汇集国内肝脏外科领域4位著名专家及其团队，结合各自中心临床经验，从不同角度探讨肝癌合并肝外转移行外科治疗的合理性。耿小平教授认为：肝癌合并肝外转移虽属进展期肝癌，但在严格控制适应证的前提下选择部分患者尝试联合外科手术的综合治疗有望获得较好预后；对部分少见肝脏恶性肿瘤则可在综合治疗的基础上对肝外转移病灶宜行更为积极的外科治疗。周俭教授认为：合并肝外转移的原发性肝癌行肝内病灶切除应以是否切实延长患者生存时间为前提。其主张依据患者具体情况选择个体化治疗方案及联合多种方式的综合治疗使患者生存获益，必要的肝内病灶切除是一种积极可行的治疗策略。王捷教授分享其团队的2例肝癌合并肝外转移患者的诊断与治疗过程，建议原发性肝癌即使出现肝外转移仍不可忽视外科手术的作用。对于部分严格筛选的患者，尤其是肝内原发病灶可切除但早期即发生肝外转移的患者，肝内原发病灶切除可带来生存获益。周伟平教授认为：肝癌合并肝外转移患者选择手术应格外慎重，应优先考虑能否提高患者生存率，在肝外转移病灶得到有效控制或完全坏死的情况下，行肝脏原发病灶切除术仍然是目前的主流观点。
Abstract:With the development of diagnostic and screening technologies, the incidence of hepatocellular carcinoma (HCC) with extrahepatic metastasis is increasing and surgical rate is also increasing. There is currently no standard of treatment. Four famous experts and their teams in hepatic surgery discussed reasonability of surgical treatment for HCC with extrahepatic metastasis based on clinical experiences. Professor Geng Xiaoping suggested that HCC with extrahepatic metastasis was classified as advanced HCC, however, under the premise of strict control of indications, selective patients undergoing comprehensive treatment combined with surgical procedures could achieve good prognosis. For some rare liver malignancies, active surgical treatment for extrahepatic metastasis based on comprehensive treatment was recommended. Professor Zhou Jian proposed that resection of intrahepatic lesions in HCC with extrahepatic metastasis should be based on the premise of whether to prolong the survival of patients. He advocated choice of individualized treatment and comprehensive treatment of multiple methods to benefit patients′ survival. The necessary intrahepatic lesion resection was a positive and feasible treatment strategy. Professor Wang Jie shared the diagnosis and treatment of 2 patients with HCC and extrahepatic metastasis, suggested that primary tumor resection might have a favorable impact on the prognosis of these patients with resectable primary tumors. Therefore, surgical treatment was important for HCC patients with extrahepatic metastasis, and surgical therapy combined with personalized systemic treatment showed survival benefit for selected patients. Professor Zhou Weiping recommended that choosing surgery for HCC with extrahepatic metastasis should be extraordinarily cautious. Priority should be given to improving the survival rate of patients. In the case of effective control or complete necrosis of extrahepatic metastases, hepatic primary tumor resection was still the current mainstream opinion.
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Keywords:
- Liver neoplasms /
- Liver cancer /
- Extrahepatic metastasis /
- Surgical procedures /
- operative
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